International Programs at Mercer University

Application for Admission to the Mercer University English Language Institute

Please fill in all information. Incomplete applications will not be considered.

Please provide the following information:* Indicates Required Field

Do you need on-campus housing?

yes

no

Are you interested in a homestay with a U.S. family?

yes

no

*When do you wish to begin your studies at the English Language Institute?

How many sessions are you planning to attend?

Do you intend to apply for a degree program?

yes

no

1.) Personal Information

*E-mail Address

*Family name

*Given name(s)

Address in Home Country

*Mailing Address 1

Mailing Address 2

*City

Province/State

Postal Code

*Country

*Telephone in home country

Fax in home country

Address in U.S.

Mailing Address 1

Mailing Address 2

City

State

Zip Code

Telephone in US

Fax in US

Miscellaneous

*Date of Birth

*City and Country of Birth

*Citizenship

*Gender

male

female

*Marital Status

single

married

(If you are bringing spouse and/or dependent children please include copies of their passports.)

2.) Educational Information

Name of last school attended

Location

Dates of attendance

From

To

This is a

Did you complete your studies?

yes

no

Did you receive a degree/diploma?

yes

no

Are you transferring from a school or university in the United States?

yes

no

Are you a US Citizen or Permanent Resident of the United States?

yes

no

If you are currently living in the United States, are you “in-status” with the U.S. BCIS (Bureau of Citizenship and Immigration Services)?

yes

no

English Level Please describe your level of English

Listening/Speaking

Writing

Reading

3.) Statement of Financial Support

This is required for F-1 Students with sponsors outside the US. If your sponsor lives inside the US, he/she will need to
fill out the “Affidavit of Support Form I-134” available from the admissions office or from www.uscis.gov.

The sponsor must send an original bank verification letter showing at least US$14,000 on account for a single student.
Students bringing dependents should have at least $4,000 extra for each additional person.

I assume responsibility for all expenses for while he/she is a student at Mercer
University English Language Institute. I am aware of the total cost per session as stated on the fee schedule.

Sponsor's name

Sponsor's Contact Information

Mailing address 1

Mailing address 2

City

Province/State

Postal Code

Telephone

Fax

I certify that the information provided in this application is true and correct to the best of my knowledge. I agree that, if accepted,
I will follow all the present and future rules, procedures, and policies of the university, as set forth in the Student Handbook,
the Code of Conduct for Students, and the Honor System. I understand that falsification of information in any admissions document is
grounds for denial of admission or may result in dismissal from Mercer University.